Community Needs Assessment

Please complete the following questionnaire to the best of your ability. We invite you to skip any question that is uncomfortable to answer.   

       

       

      
(sexual orientation, gender identity, ally status - self-identified (all that apply))

How would you describe your ethnicity?

Do you identify with a faith belief?                If yes, please specify

Are you





        Please specify

What is your current annual income?
,000
,000
,000-$50,000
,000

Do you consider yourself to have a disability?        

If yes, please specify

Do you have children?

                           

Education Level:



How long have you lived in Topeka/Shawnee County?

Needs Assessment:
Do you believe Topeka/Shawnee County is a welcoming community?       Please Elaborate

Do you believe there is a need for an LGBTQ center in Topeka/Shawnee County?      Please Elaborate

Please list LGBTQ specific services available in Topeka/Shawnee County right now - (Organization and Services Provided):

 Have you ever been denied services or felt unsafe in any of the following places?
School Felt Unsafe Elaborate if you wish
Work Felt Unsafe Elaborate if you wish
Home Denied Services Felt Unsafe Elaborate if you wish
Place of Worship   Felt Unsafe Elaborate if you wish

Bars & Clubs

  Felt Unsafe Elaborate if you wish
Health Care/Mental Health Care Settings   Felt Unsafe Elaborate if you wish
Theatre/Cinema   Felt Unsafe Elaborate if you wish
Restaurants   Felt Unsafe Elaborate if you wish
Other   Felt Unsafe Elaborate if you wish
Other Denied Services Felt Unsafe Elaborate if you wish
Other   Felt Unsafe Elaborate if you wish
Other Felt Unsafe Elaborate if you wish

How would you utilize an LGBTQ center in Topeka (indicate all that apply)

Safety
Other
Other

Other

Other
Other
Other

Other

Other
Other
Other
Community Barriers for LGBTQ People (Mark all that apply)

What is your preferred method of communication
(rank 1-6, 1 = most preferred)

Website
Facebook
Twitter
Email
Texts
Mailings/Newsletters

Would you like to volunteer with Capital City Equality Center?



If yes, please email your contact information to info@capcitycenter.org

Comments, suggestions, recommendations for future surveys -